Healthcare Provider Details

I. General information

NPI: 1790953826
Provider Name (Legal Business Name): BENJAMIN BINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

IV. Provider business mailing address

220 STEUBEN ST
MONTOUR FALLS NY
14865-9740
US

V. Phone/Fax

Practice location:
  • Phone: 607-535-8616
  • Fax: 607-210-1965
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021374-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: